Addictions Division, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Office T519, Toronto, ON, M5S 2S1, Canada.
Institute for Medical Science, University of Toronto, Toronto, ON, Canada.
BMC Psychiatry. 2018 Jun 13;18(1):189. doi: 10.1186/s12888-018-1770-3.
In 2013, an Integrated Care Pathway (ICP) for concurrent Major Depressive (MDD) and Alcohol Use (AUD) Disorders was developed at the Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada. The ICP was further implemented at 8 other clinical sites across Ontario (the DA VINCI Project) in 2015-2017. The goal of this study was to systematically describe and analyze the main clinical outcomes of the project.
Data on a non-randomized cohort of patients receiving ICP-based treatment were collected prospectively at nine clinical sites in a variety of clinical settings.
descriptive statistics, t-test, chi-square, ANOVA, generalized linear models.
Two hundred forty-six patients were enrolled, 58.8% males, mean age was 45.6 years, 170 patients received treatment at academic health centres (AHC), 49 - at community hospitals (CH) and 27 - in family health teams (FHT). There were no major differences in anamnestic parameters and depression severity between the three settings, but there were differences in baseline drinking patterns between subgroups (F = 4.271, df = 2, p = 0.015). Overall completion rate was 70.7% with no significant variation between settings (χ = 3.35, df = 2, p = 0.19). Treatment duration in AHC was the longest, and completion rates were the highest. There was a statistically significant and clinically meaningful reduction in the number of drinking days per week (1.81, t = 8.78, p < 0.001). The cohort overall demonstrated significant and meaningful reduction in severity of cravings (Penn Alcohol Craving Scale: 4.42, t = 8.63, p < 0.001) and depressive symptoms (Quick Inventory of Depressive Symptomatology: 4.25, t = 11.26, p < 0.001). While some of the baseline patient characteristics and treatment parameters varied between the settings, the variation in clinical outcomes was mostly insignificant, though clinical improvement was more pronounced in academic setting and with individual therapy.
The study demonstrated that ICP is a feasible and effective treatment for concurrent AUD and MDD that delivers meaningful clinical improvement in a variety of settings. A randomized controlled study is needed to properly compare the treatment outcomes between ICP model and treatment as usual and to further explore the role of various factors on treatment outcomes.
2013 年，加拿大安大略省多伦多成瘾与心理健康中心（CAMH）制定了同时治疗重度抑郁症（MDD）和酒精使用障碍（AUD）的综合护理路径（ICP）。该 ICP 于 2015 年至 2017 年在安大略省的 8 个其他临床站点（DA VINCI 项目）进一步实施。本研究的目的是系统地描述和分析该项目的主要临床结果。
前瞻性地在各种临床环境的 9 个临床站点收集接受 ICP 治疗的非随机队列患者的数据。
描述性统计、t 检验、卡方检验、方差分析、广义线性模型。
共纳入 246 例患者，男性占 58.8%，平均年龄 45.6 岁，170 例在学术医疗中心（AHC）接受治疗，49 例在社区医院（CH），27 例在家庭健康团队（FHT）。三个治疗环境之间的既往参数和抑郁严重程度没有明显差异，但基线饮酒模式存在差异（F=4.271，df=2，p=0.015）。总体完成率为 70.7%，治疗环境之间无显著差异（χ²=3.35，df=2，p=0.19）。AHC 的治疗时间最长，完成率最高。每周饮酒天数显著减少（1.81，t=8.78，p<0.001），具有统计学意义和临床意义。总体队列的酒精渴求（宾夕法尼亚酒精渴求量表：4.42，t=8.63，p<0.001）和抑郁症状（快速抑郁症状清单：4.25，t=11.26，p<0.001）均有显著和有意义的改善。尽管治疗环境之间存在一些基线患者特征和治疗参数的差异，但临床结果的差异大多不显著，尽管在学术环境中以及采用个体治疗时，临床改善更为明显。
研究表明，ICP 是一种可行且有效的治疗方法，可在多种环境下为并发 AUD 和 MDD 提供有意义的临床改善。需要一项随机对照研究来正确比较 ICP 模型和常规治疗之间的治疗结果，并进一步探讨各种因素对治疗结果的影响。
